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Commentary: § 85 TO § 92

The examination must be carried on with due respect to the nature of the illness and with due respect to the nature of the Materia Medica.

Some symptoms have reference to pathology and diagnosis, while others have reference only to the Materia Medica, and symptoms must be constantly weighed in the mind in order to establish their grade whether common or peculiar.

If all are found to be common symptoms, the Materia Medica is not useful. Either the examination has not been made with respect to the Materia Medica, or the symptoms are not there at all. It makes no difference as far as cure is concerned ; it does not matters  whether they are absent  in the case or whether the doctor has not found them, the key to the prescription is absent.

But if the image is round and full and complete, there are symptoms with regard to pathology, diagnosis, prognosis and Materia Medica.

When the physician comes to look over the record after an examination to get the totality of symptoms  to classify and arrange it, he will find what is peculiar, and those symptoms that are most general, and those that are common.

GRADING

Three grades are

	rare uncommon peculiar symptoms
	General symptoms
	common symptoms

These three grades 

	appear in every complete case, and
	in every complete proving of remedy.                               Homoeopathic study and observation will help  one to pick out these grades at a glance.

Every case has common symptoms, but peculiar symptoms may be absent and you must not expect to cure when peculiar symptoms are absent.

Homoeopathy is applicable in every curable case, but the great thing is to know how to apply it. The physician must sit in judgment upon the symptoms and determine whether they are peculiar or common.

physicians should note

	If the patient's discourse is incoherent, the question arises is he intoxicated or delirious, or is there breaking down of the brain and insanity ?
	The flash of the eye is important ; it will tell things that cannot be told by the nurse .
	It is important for the physician to know the value of facial expression. When the patient stares with glassy eye, is he injured about the head, is he suffering from shock, intoxication or typhoid fever, or some disease in which the mind is stunned ?  The physician immediately proceeds to ask : "How long has the patient been in bed ?" if the patient has been sick for many days with fever, tongue coated, abdomen sensitive, etc., he is fully entered upon the course of typhoid fever.
	The physician must know immediately upon entering the room what the state of the patient resembles : apoplexy or cerebrovascular accident or stroke, coma, opium poisoning, etc.

A physician is supposed to set his mind to work instantly, to ascertain the condition of the patient and what relation the symptoms maintain to the Materia Medica.

	If an opium poisoning there must be selected an antidote (as in the case of side effects of opium or prolonged intakes of drugs containing opium );
	if cerebrovascular accident or stroke, a careful taking of the symptoms in relation to the cerebral clot to prevent inflammation and symptoms relative to that state, and relative to the remedy.

The patient may be intoxicated and have apoplexy (stroke) at the same time. There is no symptom in the sick room without its value, especially in acute and serious cases.

The physician now must examine on every aspect of the case to find the nature, to know what to expect. He who disregards this is not a true homoeopathic physician ; a mere superficial application of Homoeopathy is not adequate.

After all the symptoms are written out, 

the physician must study the character: of the fever, whether it is intermittent, continued or has come on in one sudden attack ; he must know sufficient of the symptoms to judge of all these.

You will learn so much about the purpose and the aspect of every motion of the human being that you will place less and less trust on diagnostic symptoms, and learn more the value of symptoms.

You will be amazed to find how expert you will become about diagnosis and prognosis by studying the symptoms. You can learn something from every case you have access to.

	Is it a waxy face ?
	Many  of cases come into mind ; but by a process of rapid exclusion, you say it is not cholera, not hemorrhage, etc., and latterly you come to the cause of this aspect.

It is important to know instantly what the cause is, for the treatment will be different, but remember that it is nothing that you need to name that makes it important.

All these symptoms have respect to remedy and to diagnostic conditions. kent says  "So far as there is a morbid anatomy which can account for symptoms, so much less are those symptoms worth, as indicating a remedy ; if you had no other than such symptoms, you could find no remedy."

Among the many things that interfere with the examination of the patient 

The most important is the taking of medicines, or having done something, no matter what it is, that has been capable of changing the symptoms. EXAMPLE: Very commonly, the patient will present himself in the doctor's office, and after giving a long range of symptoms will relate a dose of Quinine, and he thinks he is no better, and now he applies to you for relief.

In acute diseases this is very bad and may interfere with finding the homoeopathic remedy. Very often the general state collectively both drug (ALLOPATHIC DRUG) and disease symptoms, in a very acute condition must be prescribed for, but in chronic disease the plan is different. 

For example  patient under the treatment of allopathic drug quinine given for malaria may some times does not cure and symptoms of malaria coexist with quinine.

TREATMENT :SYMPTOMS DUE TO LONG CONTINUED ALLOPATHIC DRUGS ALONG WITH THE DISEASE HE OR SHE IS SUFFERING:

The symptoms that arise after the taking of a dose of powerful medicine (allopathic /antipathic/homoeopathy not based on totality) are not indicative of a remedy, as 

1. they are confusing, 
2. they present no true image of the disease                                                                                                                                                                                                                                                                       Hence the physician has nothing to do but wait, or at most administer a well-known antidote to the drug taken.

Sometimes he must wait a considerable time until the symptoms expose themselves and express the nature of the sickness.

The confusion arising from bad prescribing is just the same as that produced by the patient's drugging. kent says "There are physicians going about who will mix up their cases and continue to prescribe for their own drug symptoms, and who, never have any idea of waiting for the true image of the disease to develop itself."

	Drugging is only a matter of changing symptoms and masking the case.
	Anything that will effect a change in the symptoms, the taking of drugs, or drinking too much wine or drinking toddy or great exposure, will mask the case, and this mask must wear away before the intelligent physician can make a cure.

The whole aim of the physician is to secure the language of nature.

If it has been masked by medicines, it cannot be secured.

 Bad prescribers  do not cure 

	They have no cures to present.
	The patients cannot well be satisfied by these things.
	It is true that once in a while a strong, vigorous, robust patient, when he gets a homoeopathic remedy, will go on getting well through a mess of symptom changing and drugging, so that in spite of this meddlesome practice he will recover. The physician in that case, does not knows  what remedy to attribute to cure, for he has given a great many remedies.

DRUGGING BY HOMOEOPATHIC MEDICINE

Kent says "But only the most vigorous constitution will stand such homoeopathic villainy, go on and get well in spite of their indulgence in wine, in eating, etc. ; it is wonderful what their own powers will do in throwing off disease." kent says "Upon that date," he says, "I took some medicine, and most of my symptoms subsided."

They lead to another picture from which you can gather nothing ; a diffusing has taken place. The symptoms may cover page upon page, and yet you do not see  any  remedy at all ; it looks as if a number of provings of drugs had been jumbled  up all together, blending symptoms here and there without any distinctness.

No individualization is possible.

MANAGEMENT OF PATIENT WITH EXCESS DRUGGING (BY ALLOPATHY, ANTIPATHY OR HOMOEOPATHIC MEDICINE THAT IS NOT BASED UPON TOTALITY.

"Now up to that date the symptoms you gathered may be just all that is necessary. KENT SAYS "Up to that date the symptoms present the image of a remedy which, if administered, may yet act, though sometimes it will fail at first because of the confusion, but after waiting a little it will act." 

Lets take illustration of belladona patient taken from kent 's materia medica

Now we come to the mucous membranes, the nose, mouth, throat, larynx, chest, the mucous membrane extending into the car through the Eustachian tube, and we have another strong feature of Bell. which characterizes most of its conditions. Great dryness; a sensation of dryness. Dryness in the nose; mouth; of the tongue; in the throat; in the chest, and such evidences as dry cough and spasmodic conditions. These are so general. that with the nose symptoms, the coryza, the throat symptoms, the cough, this is intensified; dryness of mucous membranes will generally be found. It is that way with Phos. When Phos. has a sore throat it will have dryness of the mouth, tongue and air passages. This is general as to the respiratory tract. Then there is coryza with much sneezing, "Pricking, burning in the nose." Hot sensation in the nose. The general states present Much redness of the face, much heat with the coryza; hot head, cold extremities; marked headache, because there is dryness. The very dryness itself is sometimes causative of pain, because the natural flow from the mucous membranes is dried up. Whenever we have checked secretions we have fever, and in Bell. this is marked. Checking of the discharge with fever, with heat, redness and burning; red face, burning face; heat in the face and head, and cold extremities. It says in the text, "maddening headache, with suppressed catarrh."

Now suppose that there is bad prescription. Indicated remedy belladona was not given to the case instead Arsenicum album was prescribed. After prescription of arsenicum album symptoms some what changed.

	characteristics of dryness of the mucous membrane is now absent which was orginally present.
	certain other symptoms of arsenicum album were added  The secretions and excretions of Arsenic are acrid; they excoriate the parts, causing burning. The discharge from the nose and eyes causes redness around the parts, and this is true of all the fluids from the various orifices.
	remaining symptoms are same as that of belladona.

Now you see a jumbled up case. We can see some symptoms of arsenic and other of original symptoms of the patient (that resembled belladona) were all mingled. Now what will you do? kent says  "After the administration of a remedy prescribed upon symptoms in the past I have known the remedy many times to go on acting. Again I have known that remedy to fail entirely."

I Suggest two option for the above belladona patient

	Give the original remedy belladona even if there are symptoms of arsenicum album are present. Belladona seem to act even if the arsenicum symptoms are present.                                                      or
	In such a case, wait awhile and then order will begin to come and that remedy which was indicated previous to the drugging will act, that is belladona.

Now lets up pick up examples of kent "Suppose a physician comes to you and says, "Up to a certain date I was able to hold this patient's symptoms in order with Thuja ; but then the symptoms seemed to change and I gave such and such medicines, and have never seen such good results in prescribing as I did up to that period. You must give him Thuja again, and in this way take up the thread where it was lost."

Analyse the image of the case where the order was lost ; because that is where the picture must be found.

 The symptoms and the troubles which presented themselves previous to the use of the medicines, or several days after their discontinuance, give the true cardinal notion of the original form of the illness."

This is the idea, get the original form of the malady. To do this, at times we have to trace through a heap of difficulties and conditions to get back to the original form of the trouble

The symptoms at that time stood out indicating this medicine, but since due to wrong prescription  then there has been nothing but confusion, nothing that can be tied to, nothing that can be examined ; it appears to have no relation to anything. Very often we can take up the thread and get back to the remedy that was clearly indicated, even many  years say 10 or 15 or 20 years before.

If that remedy was indicated then, and was not given, the cure that was possible by that remedy or a similar one is the only thing to be considered ; that is the only remedy in the case.

Since that time the patient has been in continued turmoil from the action of unwanted drugs. Because it was twenty years ago there is no reason that you should not think of that drug.

The patient's disease has not been cured, it has only been changed and modified ; but it is the same patient, and the same sickness and requires the same medicine.

If the disease has been complicated by drugs, however, you cannot always get the action of that medicine which the patient needs for the disease per se, but after the drugs have been antidoted you will have to give that very medicine that you figured out and he will be cured.

It is necessary also to detect the changes all along the line of advancement to know the disease at its beginnings, its earlier manifestations, its symptoms and as endings.

Let me take another example given by kent "You find, say, most violent neuralgic pains along the course of nerves in an adult patient, and for these you administer remedies until you are tired and get only temporary relief ; but you discover that in his childhood he had an eczema, and you will find it looks like Mezereum, and see its violent neuralgias are similar to those of your patient. The administration of Mezereum cures this neuralgia and brings back the eruption that he had in his babyhood, and he goes on to recovery. Without getting that view of the old scald head, you would not have thought of Mezereum. Or, instead of Mezereum, Sepia may have had the likeness of that scald head, and he may now have the most striking and characteristic symptoms of Sepia ; for behold the little things that have been put into such a turmoil by a bad drugging are tinder Sepia, and you put your patient on Sepia, and these last appearing symptoms go first and the eruption comes back upon the head and behind the ears, and Sepia has cured him. When these things are seen one after another in everyday practice the physician must begin to wonder if there is not some truth in it all."

And as sure as you live, 

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